What next for the NHS? A message for Mr Corbyn

Junior doctors working with the NHS on strike

Labour Party annual conference will take place at Brighton on 24–27 September. Prof. Rajan Madhok, one of the most prominent medical professionals from the Asian community, comments on the plight of Britain’s state funded NHS.

Junior doctors working with the NHS on strike

I start with a confession and an update – the confession is that yes, I gave up the ‘fight’ and update is that I am energised.  After the ‘Jarrow’ march in 2014*, I became disillusioned with the state of the NHS and the nation and resigned from any remaining commitments; I had already been made redundant from the NHS few years previously after signing the Confidentiality Agreement.

What I saw on the march was the huge gap between the reality – dire – and the political solutions – dreadful. I did not buy into the ‘Labour’ party as the saviour of the NHS and felt that they were still milking Nye Bevan and infact under Tony Blair were the worst thing that could ever have happened.

It seemed to me that there was no way out and we were totally stuck with Neo-Liberalism in the UK and I dropped out to catch up on the work:life balance that I had ignored. But more importantly I became interested in deeper understanding of why things were so – the usual meaning of life question – and began extensive and very ecletic reading. I can spare you the details since as the saying goes the ‘Answer is 42’, and actually it is not the answer but the self-discovery journey that matters. Overall, things were ever thus and will be thus until mankind destroys itself and which may not be long now according to Harari*.

Prof Rajan Madhok with Mr Peter W Mount, chairman of the Central Manchester Foundation Trust, Tony Lloyd, Manchester Police Commissioner and Dr Kailash Chand MBE during an event organised by Asian Lite

The update is whilst not actively engaging with the NHS issues I went into ‘training’ and began by  becoming a keen reader and observer and by discussing various aspects of life such as human behaviour, national and international politics, religion, poetry to name a few.  And although I had also stopped social media I did pop up on Twitter to note and welcome Corbyn’s victory as the Labour Leader, and since then have followed his journey, and the wider political developments including the arrival of Theresa May.

I spent numerous hours explaining my thinking about why I supported him (and not the Party), and why I voted for Brexit (sic) to various friends both in the UK and overseas and was amused to see the pitying (and incomprehensible) looks in their faces! I have never been a party member (of any political party) but was pleased when my son, a junior doctor, signed up for Labour. I made a distinction between Labour Party and Corbyn since I detested some of the Labour grandees and was very wary of their machinations to bring him down. I had extensively interacted with some of the Labour health advisors especially in my active Jarrow March phase, and did not ‘get’ their solutions for the NHS since I found that their thinking was just variations on the old themes and basically workarounds. Although I liked Allyson Pollock’s NHS Reinstatement Bill I felt that it would not work.

And this election has reminded me of these last few years of learning and thinking, and knowing that the tide is turning has energised me. But before we get carried away, some caution is necessary. Not just because the forces against Corbyn will renew their efforts and there are no guarantees that he will prevail (as I write this sitting in Mumbai, the first salvo has been fired – but more importantly because further work is needed for a compelling vision for the NHS. Chanting the founding principles of the NHS shows the ignorance about reading but not learning from history – these principles were of a time and indeed as we know failed within a few years when demand exceeded supply. What is needed are the new principles for designing the 21st century NHS.

Junior doctors working with the NHS on strike in London (File)

In my 2011 article on lessons from the NHS* – pity FMLM has it for members only and hence a paywall), I had written: “If I was to name (my) main disappointments, then the biggest stumbling block has been the primary-secondary care (and some would argue health and social care) divide, and rather than find ways of bridging it, the consistent policy direction with emphasis on purchasing/commissioning has reinforced it.

The second is the denial by politicians that the NHS is not affordable and has to set some limits; it can not provide world class state of the art health care to everyone. Rationing has become a taboo word despite evidence, and lately increasing evidence, that some sort of rationing is already happening.  Thirdly, I have been really pleased with some of the major developments such as the work of the NICE, NPSA, National Institute for Innovation and Improvement  and National Service Frameworks, which have generated unprecedented, and unparalleled elsewhere, intellectual capital, but disappointed to see that we have failed to fully capitalise on this.

Amongst other reasons, the failure of execution is partly to do with constant restructuring and resultant instability and partly to do with overall leadership. Finally, and the subject of this paper later, is the limited leadership by the doctors, for various reasons including the lack of career progression in medical management and the associated stresses of the roles with limited  incentives.”

We need to acknowledge such challenges and then design the new NHS – Form should follow Function – and create something relevant and sustainable for the next few decades; only so much can be achieved by workarounds which is what is happening with the new initiatives on STPs/ACO etc (and I have frankly lost the plot). Taxing rich to pay for ‘As is NHS’ is a recipe for disaster; providing free for all to everyone from cradle to grave 21st century healthcare with its advances in science and technology is impossible in the face of a changing world with Artifical Intelligence, Machine Learning, Robotics and an unimaginable and frankly horrifying job situation*.

Health has been and will remain an election issue and politicians have a history of abusing the NHS in power and exploiting it in opposition. I hope Jeremy Corbyn will change this, just as he has done so far politically, and set a new direction for it. He will have the whole country and the NHS workforce rooting for him, and generations will remember him. In my view it is a No-Brainer, Go for it Jeremy and good luck to us all.